Mercury and Old Cavities

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I've heard that my old silver fillings probably contain dangerous mercury, and I should have them replaced. I don't think insurance will pay for replacements —but I don't want to leave poison in my mouth! Is it really dangerous to leave old fillings in place? What are the options for replacing them?

— Jill, New York

The safety of dental silver fillings (amalgams) is one of the hottest topics in dentistry today. Silver fillings are called amalgam restorations because they are an amalgamation of several metals (tin, zinc, copper, and silver) combined with elemental mercury. These metals are mixed together and then placed in the carefully prepared holes made by the dentist. Over the years, people have questioned whether the mercury portion of the fillings leaches, or comes out, and if so, whether the mercury affects their health.

It seems as if the answer is no. Recently a series of articles appeared in national publications, including the Wall Street Journal (September 12, 2006), questioning the safety and long-term efficacy of amalgams. However, an FDA advisory panel had reported on September 6 that there was no new scientific evidence to justify regulation of dental amalgams. The report was based on a review of 34 recent studies, which found "no significant new information," though the panel did say that more research is needed.

Immediately after the FDA announcement, the American Dental Association issued a news release welcoming further study on amalgam safety, while reiterating that "the overwhelming weight of scientific evidence supports the safety and efficacy of dental amalgam" and that amalgam should remain available for dentists and patients.

I have a number of amalgams in my mouth that my dad (also a dentist) placed there 30 to 40 years ago. I personally feel they are safe and would not remove them unless I had a crack or decay around them. Amalgams are amazing restorations and are relatively low-cost, especially given the length of time that they last.

However, fillings don't last forever; your dentist must check the integrity of them during your regular cleaning appointments. If it should come to pass that an old amalgam needs replacement because of a crack or decay, you do have options. Replacement fillings can be made of gold (one of the best materials for teeth but no longer stylish), tooth-colored bonding materials, or tooth-colored porcelain. Discuss the options with your dentist to determine which material is best suited for your mouth. People who grind their teeth may be better off with gold restorations since porcelain tends to fracture more easily. It also depends on how much tooth structure has been lost to decay and what type of bite you have.

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